CIT 0001E : Kit - Application for a Citizenship Certificate from INSIDE Canada - (Proof of Citizenship) Under Section 3

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CIT 0001E : Kit - Application for a Citizenship Certificate from INSIDE Canada - (Proof of Citizenship) Under Section 3 Powered By Docstoc
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            Citizenship and      Citoyenneté et                                                  For official use only                               PAGE 1 OF 4
            Immigration Canada   Immigration Canada
                                                             UCI no.


            Application for                                  Case ID
                                                                                          Section 8 notice
            a Citizenship Certificate                        Current Act                  Former Act
            from Inside Canada
            (Proof of Citizenship)                           Certificate no.

            Under Section 3                                  Return original
                                                                                          Approved
                                                             document(s)
                                                             Signature                            D    M       Y
Note: If you are completing this application
      for a child under 18 years of age,
      remember all questions are about                             Notify:
      the child. Skip questions 5 and 6.
                                                             Send certificate to:
Please PRINT in ink or TYPE                                                                                                 Protected when completed

 1                     I want service in           English                   French               Please check ( ) one

 2    Have you ever had a certificate of Canadian citizenship or naturalization?                      No             Yes
      If yes, give information that appears on the certificate.
       Surname/Last name                  Given name(s)                                        Certificate number               Date
                                                                                                                                Day     Month      Year



      I am applying for a replacement:                  a) to update certificate
                                                           (previous certificate enclosed)
                                                        b) to replace a:              stolen           lost        destroyed              certificate.

      Was the theft/loss reported to the police?                       NoYes
      Please give details of the theft/loss/destruction (when, where, how and what?)




      Note: It is illegal to have more than one valid certificate of citizenship or naturalization. If you have any certificate of citizenship and
                naturalization or any pink transmission copy of a certificate, you have to send it back. If you find a lost certificate after you
                get your replacement certificate, you have to send it back to the Case Processing Centre in Sydney, Nova Scotia.
              Name to appear on              Surname/Last name
 3         citizenship certificate
      (supporting documentation              Given name(s)
                        required)
           Refer to instructions regarding
            name change documentation
       List any other names used in          Surname/Last name                                        Given name(s)
        the past or now being used,
           (for example, birth name,
                    nicknames, etc.)



 4     A
                                              Day      Month           Year
                                                                                       Refer to instructions regarding
                           Date of birth                                               request to amend date of birth
       B Place and country of birth

                                                                                                                          cm
       C        Personal information         Sex         Male          OR Female                  Height            OR                Colour
                                                                                                                                      of eyes
                                                                                                                   ft      in

                          Marital status Single              Married           Common-            Widowed                Divorced          Separated
                                                                                   law
                                                      (AUSSI DISPONIBLE EN FRANÇAIS - CIT 0001 F)
CIT 0001 (06-2005) E                                ALSO AVAILABLE ON CIC WEB SITE AT : http://www.cic.gc.ca
                                                                                                                                               PAGE 2 OF 4

 5    If you are a woman and married before January 1, 1947, answer the following questions. If you married on or after
      January 1, 1947, this question does not apply to you. Go to part 6.
                        Information on           Husband's surname/last name
                         your husband
                (Provide details of every        Given name(s)
                 marriage before 1947.)
                                                                                                                    Day      Month           Year
            Husband's country of birth                                                              Date of
                                                                                                    birth
                                                                                                                    Day      Month           Year
                       Country of marriage                                                          Date of
                                                                                                    marriage

                           Is your husband a
                                                  No         Yes              by birth      or   other
                           Canadian citizen?
                                                                                                                    Day      Month           Year
 Number on husband's citizenship
         certificate (if applicable)                                                                Date

      Please use another piece of paper if you need more space to list other marriages.

 6    Other nationalities
      Are you a citizen of one or more countries other than Canada?                                 No            Yes
      If yes, list the country or countries, date and how you obtained this citizenship.




      Absences from Canada
      Did you leave Canada for 1 year or longer before 1977?                                        No            Yes                Give details
                                                                                                                                     below:

                FROM                    TO                        DESTINATION                                      REASON
            Y          M     D      Y        M   D           What country did you go to?                 Why did you go to this country?




 7                 Telephone number(s)           Home (         )                          Work (        )                            Ext.

                                                 Cell.   (       )

                       Home address
                      Mailing address
    (if different from home address)                                                                              Postal code


                                                                                                                  Postal code



CIT 0001 (06-2005) E
                                                                                                                                                     PAGE 3 OF 4


 8     Applicant's Parents                    Answer all of the following questions:
                                                  Natural               Adoptive                            Natural                   Adoptive
                        Relationship to you        father                 father                            mother                     mother
                                                                      FATHER                                               MOTHER
                                                                                                      Maiden name
                       Surname/Last name

                            Given name(s)
                                                                            Day Month      Year                                      Day Month      Year
             Country and date of birth
                                                                                                                                     Day Month      Year
               Married in what country                                                                        Date of marriage
                                              How did he obtain Canadian citizenship?                 How did she obtain Canadian citizenship?
                  Additional information



                                              Did he leave Canada for more than 1 year                Did she leave Canada for more than 1 year
                                              before 1977?                                            before 1977?
                                               No          Yes                                         No         Yes
                                                    From         To       Destination (Country)            From           To       Destination (Country)
                                                M      Y     M        Y                                M      Y       M        Y




                                              Is he or was he a citizen of a country other            Is she or was she a citizen of a country
                                              than Canada?                                            other than Canada?
                                                                      Give details                                            Give details
                                                No      Yes           (country, date and how           No       Yes           (country, date and how
                                                                          citizenship was obtained)                                citizenship was obtained)




                                              Was he employed in Canada by a foreign                  Was she employed in Canada by a foreign
                                              government or international agency?                     government or international agency?


                                               No          Yes            Give details                 No         Yes              Give details




                                              If father was born in Canada, was one of If mother was born in Canada, was one of
                                              his parents employed by a foreign her parents employed by a foreign
                                              government or international agency?      government or international agency?
                                               No          Yes            Give details                 No         Yes              Give details




CIT 0001 (06-2005) E
                                                                                                                                                    PAGE 4 OF 4


 9    Are you claiming Canadian citizenship by birth outside Canada to a Canadian parent?

        No             Yes

      Have you ever lived in Canada?                                                                  Day      Month          Year

        No             Yes           If yes, on what date did you enter Canada to live?

      Were you a British subject living in Canada before 1947?                                        Day      Month          Year

        No             Yes           If yes, on what date did you enter Canada to live?



10        I understand the content of this form. I declare that the information provided is true, correct and complete, and
          that the photographs enclosed are a true likeness of me. I understand that if I make a false declaration, or fail to
          disclose all information material to my application, my citizenship certificate could be taken away and I could be
          charged under the Citizenship Act.



                                                                                                                               Day     Month        Year

                 Signature                                           Place                                             Date



          If applicant is under 14 years of age, signature of parent/guardian:

                                                                                                                               Day     Month        Year

                 Signature                                           Place                                             Date




           REMEMBER:
           If you are sending more than one application, send all of them together in one envelope. The applications
           will be processed together.




                                                               Protected Information
                                                       Personal Information Bank CIC PPU 050
  The information you provided on this form is collected under the authority of the Citizenship Act and will be used to determine eligibility for the grant of
  Canadian citizenship according to the requirements of the Act, and to maintain a record of persons to whom citizenship certificates were issued. It will be
  retained in the Personal Information Bank CIC PPU 050. It may be shared with other organizations in accordance with the consistent use of information
  under the Privacy Act. Under the Privacy Act and the Access to Information Act individuals have the right to protection of and access to their personal
  information. Details on these matters are available at infosource.gc.ca and through the Citizenship and Immigration Canada Call Centre. Infosource is also
  available at Public Libraries in Canada.

CIT 0001 (06-2005) E